BACKGROUND: Margin status is one of the strongest prognosticators after resection of pancreatic ductal adenocarcinoma (PDAC). The clinical significance of pancreatic intraepithelial neoplasia (PanIN) at a surgical margin has not been established. METHODS: A total of 208 patients who underwent R0 resection for PDAC between 2004 and 2008 were selected. Intraoperative frozen section slides containing the final pancreatic parenchymal transection margin were evaluated for presence or absence, number, and grade of PanINs. Data were compared to clinicopathologic factors, including patient survival. RESULTS: PanIN lesions were present in margins in 107 of 208 patients (51.4%). Median number of PanINs per pancreatic resection margin was 1 (range, 1-11). A total of 72 patients had PanIN-1 (34.6%), 44 had PanIN-2 (21.1%), and 16 had PanIN-3 (7.2%) at their margin. Overall median survival was 17.9 (95% confidence interval, 14-21.9) months. Neither the presence nor absence of PanIN nor histological grade had any significant correlation with important clinicopathologic characteristics. There were no significant survival differences between patients with or without PanIN lesions at the resection margin or among patients with PanIN-3 (carcinoma in situ) versus lower PanIN grades. However, patients with R1 resection had a significantly worse outcome compared with patients without invasive cancer at a margin irrespective of the presence of PanIN (P=0.02). CONCLUSIONS: The presence of PanINs at a resection margin does not affect survival in patients who undergo R0 resection for PDAC. These results have significant clinical implications for surgeons, because no additional resection seems to be indicated when intraoperative frozen sections reveal even high-grade PanIN lesions.
BACKGROUND: Margin status is one of the strongest prognosticators after resection of pancreatic ductal adenocarcinoma (PDAC). The clinical significance of pancreatic intraepithelial neoplasia (PanIN) at a surgical margin has not been established. METHODS: A total of 208 patients who underwent R0 resection for PDAC between 2004 and 2008 were selected. Intraoperative frozen section slides containing the final pancreatic parenchymal transection margin were evaluated for presence or absence, number, and grade of PanINs. Data were compared to clinicopathologic factors, including patient survival. RESULTS: PanIN lesions were present in margins in 107 of 208 patients (51.4%). Median number of PanINs per pancreatic resection margin was 1 (range, 1-11). A total of 72 patients had PanIN-1 (34.6%), 44 had PanIN-2 (21.1%), and 16 had PanIN-3 (7.2%) at their margin. Overall median survival was 17.9 (95% confidence interval, 14-21.9) months. Neither the presence nor absence of PanIN nor histological grade had any significant correlation with important clinicopathologic characteristics. There were no significant survival differences between patients with or without PanIN lesions at the resection margin or among patients with PanIN-3 (carcinoma in situ) versus lower PanIN grades. However, patients with R1 resection had a significantly worse outcome compared with patients without invasive cancer at a margin irrespective of the presence of PanIN (P=0.02). CONCLUSIONS: The presence of PanINs at a resection margin does not affect survival in patients who undergo R0 resection for PDAC. These results have significant clinical implications for surgeons, because no additional resection seems to be indicated when intraoperative frozen sections reveal even high-grade PanIN lesions.
Authors: Jordan M Winter; John L Cameron; Kurtis A Campbell; Meghan A Arnold; David C Chang; Joann Coleman; Mary B Hodgin; Patricia K Sauter; Ralph H Hruban; Taylor S Riall; Richard D Schulick; Michael A Choti; Keith D Lillemoe; Charles J Yeo Journal: J Gastrointest Surg Date: 2006-11 Impact factor: 3.452
Authors: Thomas J Howard; Joseph E Krug; Jian Yu; Nick J Zyromski; C Max Schmidt; Lewis E Jacobson; James A Madura; Eric A Wiebke; Keith D Lillemoe Journal: J Gastrointest Surg Date: 2006-12 Impact factor: 3.452
Authors: J Kim; H A Reber; S M Dry; D Elashoff; S L Chen; N Umetani; M Kitago; O J Hines; K K Kazanjian; S Hiramatsu; A J Bilchik; S Yong; M Shoup; D S B Hoon Journal: Gut Date: 2006-05-08 Impact factor: 23.059
Authors: T A Sohn; C J Yeo; J L Cameron; L Koniaris; S Kaushal; R A Abrams; P K Sauter; J Coleman; R H Hruban; K D Lillemoe Journal: J Gastrointest Surg Date: 2000 Nov-Dec Impact factor: 3.452
Authors: J P Neoptolemos; D D Stocken; J A Dunn; J Almond; H G Beger; P Pederzoli; C Bassi; C Dervenis; L Fernandez-Cruz; F Lacaine; J Buckels; M Deakin; F A Adab; R Sutton; C Imrie; I Ihse; T Tihanyi; A Olah; S Pedrazzoli; D Spooner; D J Kerr; H Friess; M W Büchler Journal: Ann Surg Date: 2001-12 Impact factor: 12.969
Authors: Ralph H Hruban; Kyoichi Takaori; David S Klimstra; N Volkan Adsay; Jorge Albores-Saavedra; Andrew V Biankin; Sandra A Biankin; Carolyn Compton; Noriyoshi Fukushima; Toru Furukawa; Michael Goggins; Yo Kato; Gunter Klöppel; Daniel S Longnecker; Jutta Lüttges; Anirban Maitra; G Johan A Offerhaus; Michio Shimizu; Suguru Yonezawa Journal: Am J Surg Pathol Date: 2004-08 Impact factor: 6.394
Authors: John P Neoptolemos; Deborah D Stocken; Helmut Friess; Claudio Bassi; Janet A Dunn; Helen Hickey; Hans Beger; Laureano Fernandez-Cruz; Christos Dervenis; François Lacaine; Massimo Falconi; Paolo Pederzoli; Akos Pap; David Spooner; David J Kerr; Markus W Büchler Journal: N Engl J Med Date: 2004-03-18 Impact factor: 91.245
Authors: Olca Basturk; Seung-Mo Hong; Laura D Wood; N Volkan Adsay; Jorge Albores-Saavedra; Andrew V Biankin; Lodewijk A A Brosens; Noriyoshi Fukushima; Michael Goggins; Ralph H Hruban; Yo Kato; David S Klimstra; Günter Klöppel; Alyssa Krasinskas; Daniel S Longnecker; Hanno Matthaei; G Johan A Offerhaus; Michio Shimizu; Kyoichi Takaori; Benoit Terris; Shinichi Yachida; Irene Esposito; Toru Furukawa Journal: Am J Surg Pathol Date: 2015-12 Impact factor: 6.394
Authors: Benjamin G Hassid; Aimee L Lucas; Marcela Salomao; Chunhua Weng; Feng Liu; Lauren G Khanna; Sheila Kumar; Caroline Hwang; John A Chabot; Harold Frucht Journal: Pancreas Date: 2014-10 Impact factor: 3.327
Authors: Volkan Adsay; Mari Mino-Kenudson; Toru Furukawa; Olca Basturk; Giuseppe Zamboni; Giovanni Marchegiani; Claudio Bassi; Roberto Salvia; Giuseppe Malleo; Salvatore Paiella; Christopher L Wolfgang; Hanno Matthaei; G Johan Offerhaus; Mustapha Adham; Marco J Bruno; Michelle D Reid; Alyssa Krasinskas; Günter Klöppel; Nobuyuki Ohike; Takuma Tajiri; Kee-Taek Jang; Juan Carlos Roa; Peter Allen; Carlos Fernández-del Castillo; Jin-Young Jang; David S Klimstra; Ralph H Hruban Journal: Ann Surg Date: 2016-01 Impact factor: 12.969
Authors: Colin M Court; Jacob S Ankeny; Shuang Hou; Hsian-Rong Tseng; James S Tomlinson Journal: Expert Rev Mol Diagn Date: 2015-09-21 Impact factor: 5.225
Authors: Seung-Mo Hong; Michael Goggins; Christopher L Wolfgang; Richard D Schulick; Barish H Edil; John L Cameron; Adriana Handra-Luca; Joseph M Herman; Ralph H Hruban Journal: Am J Surg Pathol Date: 2012-02 Impact factor: 6.394